1. Field of the Invention
This invention relates to a medicinal aerosol formulation for treating diabetes, and more particularly, to a medicinal aerosol formulation comprising a mixture of an insulin or an insulin analog and another xcex2-cell hypoglycemic medicament.
2. Description of the Related Art
Delivery of drugs to the lung by way of inhalation is an important means of treating a variety of conditions, including such common local conditions as cystic fibrosis, pneumonia, bronchial asthma and chronic obstructive pulmonary disease and some systemic conditions, including hormone replacement, pain management, immune deficiency, erythropoiesis, diabetes, etc. Steroids, xcex22 agonists, anti-cholinergic agents, proteins and polypeptides are among the drugs that are administered to the lung for such purposes. Such drugs are commonly administered to the lung in the form of an aerosol of particles of respirable size (less than about 10 xcexcm in diameter). The aerosol formulation can be presented as a liquid or a dry powder. In order to assure proper particle size in a liquid aerosol, particles can be prepared in respirable size and then incorporated into a colloidal dispersion either containing a propellant as a pressurized metered dose inhaler (PMDI) or air, such as in the case of a dry powder inhaler (DPI). Alternatively, formulations can be prepared in solution or emulsion form in order to avoid the concern for proper particle size in the formulation. Solution formulations must nevertheless be dispensed in a manner that produces particles or droplets of respirable size.
For MDI application, once prepared, an aerosol formulation is filled into an aerosol canister equipped with a metered dose valve. In the hands of the patient the formulation is dispensed via an actuator adapted to direct the dose from the valve to the patient.
What is needed and desired is a stable aerosol formulation for the treatment of diabetes and the conditions related thereto.
It has surprisingly been found that a novel and stable medicinal aerosol formulation of an insulin or an insulin analog combined with a xcex2-cell hypoglycemic medicament can be obtained without the use of a surfactant, such as sorbitan trioleate. The selected insulin or insulin analog is combined with another xcex2-cell hypoglycemic medicament, and optionally other diabetic medicaments such as for example the xcex1 cell hormone, glucagon.
This application makes reference to U.S. application Ser. No. 09/209,228 filed Dec. 10, 1998, now U.S. Pat. No. 6,261,539 B1, issued Jul. 17, 2001 which is incorporated hereinto by reference in its entirety.
This invention involves a stable aerosol suspension formulation suitable for pressurized delivery which comprises (a) a particulate insulin combination, and (b) a suitable fluid carrier.
By an xe2x80x9cinsulin combinationxe2x80x9d is meant a selected insulin or insulin analog combined with at least one other xcex2-cell hypoglycemic medicament or drug, such as an amylin.
The term xe2x80x9cinsulinxe2x80x9d shall be interpreted to encompass natural extracted human insulin, recombinantly produced human insulin, insulin extracted from bovine and/or porcine sources, recombinantly produced porcine and bovine insulin and mixtures of any of these insulin products. The term is intended to encompass the polypeptide normally used in the treatment of diabetics in a substantially purified form but encompasses the use of the term in its commercially available pharmaceutical form, which includes additional excipients. The insulin ispreferably recombinantly produced and may be dehydrated (completely dried) or in solution.
The terms xe2x80x9cinsulin analog,xe2x80x9d xe2x80x9cmonomeric insulinxe2x80x9d and the like are used interchangeably herein and are intended to encompass any form of xe2x80x9cinsulinxe2x80x9d as defined above wherein one or more of the amino acids within the polypeptide chain has been replaced with an alternative amino acid and/or wherein one or more of the amino acids has been deleted or wherein one or more additional amino acids has been added to the polypeptide chain or amino acid sequences which act as insulin in decreasing blood glucose levels. In general, the xe2x80x9cinsulin analogsxe2x80x9d of the present invention include xe2x80x9cinsulin lispro analogs,xe2x80x9d as disclosed in U.S. Pat. No. 5,547,929, incorporated hereinto in its entirety by reference, insulin analogs including LysPro insulin and humalog insulin, and other xe2x80x9csuper insulin analogsxe2x80x9d, wherein the ability of the insulin analog to affect serum glucose levels is substantially enhanced as compared with conventional insulin as well as hepatoselective insulin analogs which are more active in the liver than in adipose tissue. Preferred analogs are monomeric insulin analogs, which are insulin-like compounds used for the same general purpose as insulin such as insulin lispro i.e., compounds which are administered to reduce blood glucose levels.
A suitable xcex2-cell hypoglycemic medicament is one selected from an amylin. An xe2x80x9camylinxe2x80x9d includes natural human amylin, bovine, porcine, rat, rabbit amylin, as well as synthetic, semi-synthetic or recombinant amylin or amylin analogs including pramlintide and other amylin agonists as disclosed in U.S. Pat. No. 5,686,411, and U.S. Pat. No. 5,854,215, both of which are incorporated hereinto by reference in their entirety.
Combined with the insulin combination, e.g. an insulin plus an amylin, is another diabetic medicament. Typically this other medicament is the a cell hormone glucagon. Other diabetic medicaments which can be employed are acetohexamide, chlorpropamide, tolazemide, tolbutamide, glipizide, glyburide, glucophage, phentolamine, etc.
For purposes of the formulations of this invention, which are intended for inhalation into the lungs, the insulin combination is preferably micronized whereby a therapeutically effective amount or fraction (e.g. ninety percent or more) of the insulin combination is particulate. Typically, the particles have a diameter of less than about 10 microns, and preferably less than about 5 microns, in order that the particles can be inhaled into the respiratory tract and/or lungs.
The particulate insulin combination is present in the inventive formulations in a therapeutically effective amount, that is, an amount such that the drug can be administered as a dispersion, an aerosol, such as topically, or via oral or nasal inhalation, and cause its desired atherapeutic effect, typically preferred with one dose, or through several doses. The particulate insulin combination is administered as an aerosol from a conventional valve, e.g., a metered dose valve, through an aerosol adapter also known as an actuator.
The term xe2x80x9camountxe2x80x9d as used herein refers to quantity or to concentration as appropriate to the context. The amount of the insulin combination or formulation that constitutes a therapeutically effective amount varies according to factors such as the potency of the particular insulin or insulin analog and the particular xcex2-cell hypoglycemic medicament or medicaments used, as well as the other diabetic medicaments, if used, the route of administration of the formulation, and the mechanical system used to administer the formulation. A therapeutically effective amount of the insulin combination can be selected by those of ordinary skill in the art with due consideration of such factors. Generally a therapeutically effective amount will be from about 0.001 parts by weight to about 5 parts by weight based on 100 parts by weight of the propellant.
Typically, the insulin combination comprises a selected insulin present in an amount of 0.0001 to about 5 parts by weight of the insulin or insulin analog to about 0.0001 to about 5 parts by weight of the selected xcex2-cell hypoglycemic amylin or mixture thereof e.g. an amylin/insulin mixture. Typically, the mixtures of xcex2-cell hypoglycemic medicaments in their respective ranges could be combined with a glucagon or glucagon analog or other diabetic medicament in a concentration range of about 0.001 to about 10 parts by weight based on 100 parts by weight of the propellant.
A suitable fluid carrier is selected. A suitable fluid includes air, a hydrocarbon, such as n-butane, propane, isopentane, etc., or a propellant. A suitable propellant is any fluorocarbon, e.g. a 1-6 hydrogen containing flurocarbon, such as CHF2CHF2, CF3CH2F, CH2F2CH3 and CF3CHFCF3; a perfluorocarbon, e.g. a 1-4 carbon perfluorocarbon, such as CF3CF3, CF3CF2CF3; or any mixture of the foregoing, having a sufficient vapor pressure to render them effective as propellants. Some typical suitable propellants include conventional chlorofluorocarbon (CFC) propellants such as mixtures of propellants 11, 12 and 114 or a mixture of any of the foregoing propellants. Non-CFC propellants such as 1,1,1,2-tetrafluoroethane (Propellant 134a), 1,1,1,2,3,3,3-heptafluoropropane (Propellant 227) or mixture thereof are preferred. The propellant is preferably present in an amount sufficient to propel a plurality of the selected doses of drug from an aerosol canister.
Optionally, a suitable stabilizer is selected. A suitable stabilizer is a xe2x80x9cwater additionxe2x80x9d. As used herein a xe2x80x9cwater additionxe2x80x9d is an amount of water which (1) is added, either initially with other components of the aerosol formulation, e.g. insulin combination and propellant, or after the other components, e.g. insulin combination, fluid carrier, are combined and processed, (2) is in addition to the water which is always present and which develops during processing and/or storage of the aerosol formulation, i.e. xe2x80x9cdevelopedxe2x80x9d or xe2x80x9cnascentxe2x80x9d formulation water, and (3) is present in an amount which further stabilizes medicinal aerosol formulation having nascent formulation water.
An aerosol formulation preferably comprises the water addition in an amount effective to more effectively stabilize the formulation relative to an identical formulation not containing the water addition, i.e. containing only nascent formulation water, such that the insulin combination does not settle, cream or flocculate after agitation so quickly as to prevent reproducible dosing of the insulin combination. Reproducible dosing can be achieved if the formulation retains a substantially uniform drug concentration for about fifteen seconds to five minutes agitation.
The particular amount of the water addition that constitutes an effective amount is dependent upon the particular propellant and on the particular insulin combination used in the formulation. It is therefore not practical to enumerate specific effective amounts for use with specific formulations of the invention, but such amounts can readily be determined by those skilled in the art with due consideration of the factors set forth above. Generally, however, the water addition must be present in a formulation in an amount in excess of the concentration of the nascent formulation water. Such concentration of nascent formulation water typically ranges up to 300 parts by weight per one million parts by weight of the total weight of the aerosol formulation. Accordingly, the water addition in excess of this nascent water concentration typically ranges from about 10 parts by weight to about 5000 parts by weight per one million parts by weight of the total aerosol formulation weight. Most preferred is that the concentration of the water addition is from about 500 parts by weight to about 5000 parts by weight per one million parts by weight of the total weight of the medicinal aerosol formulation.
It is to be emphasized that this is an amount which exceeds the amount of nascent or developed formulation water. It is also to be stressed that this amount of water addition can be added and initially combined with the other components of the formulation, e.g. an insulin and an amylin and fluid carrier, e.g. 1,1,1,2-tetrahydrofluoroethane, or added to the resultant formulation after these other components have been processed, e.g. prior to or subsequent to storage.
It has surprisingly been found that the formulation of the invention is stable without the necessity of employing a cosolvent, such as ethanol, or surfactants. However, further components, such as conventional lubricants or surfactants, cosolvents, ethanol, etc., can also be present in an aerosol formulation of the invention in suitable amounts readily determined by those skilled in the art. In this regard, reference is made to U.S. Pat. No. 5,225,183, which is incorporated by reference hereinto in its entirety. Typically, a co-solvent such as ethanol is added in an amount ranging from 0.5 to 10% by weight of the total weight of the formulation.
A most preferred formulation comprises the insulin combination, the fluid carrier, the ethanol cosolvent and the water addition, for example, an insulin and an amylin medicament, 1,1,1,2-tetrafluoroethane, ethanol and the water addition.
Generally the formulations of the invention can be prepared by combining (i) the selected insulin combination in an amount sufficient to provide a plurality of therapeutically effective doses; (ii) the fluid or propellant in an amount sufficient to propel a plurality of doses e.g. from an aerosol canister; and (iii) optionally, the water addition in an amount effective to further stabilize each of the formulations; and (iv) any further optional components, e.g. ethanol as a cosolvent other diabetic medicaments, e.g. glucagon; and dispersing the components. The components can be dispersed using a conventional mixer or homogenizer, by shaking, or by ultrasonic energy as well as by the use of a beadmill or a microfluidizer. Bulk formulations can be transferred to smaller individual aerosol vials by using valve to valve transfer methods, pressure filling or by using conventional cold-fill methods. It is not required that a component used in a suspension aerosol formulation be soluble in the fluid carrier, e.g. the propellant. Those that are not sufficiently soluble can be coated onto the drug particles in an appropriate amount and the coated particles can then be incorporated in a formulation as described above.
Aerosol canisters equipped with conventional valves, preferably metered dose valves, can be used to deliver the formulations of the invention. It has been found, however, that selection of appropriate valve assemblies for use with aerosol formulations is dependent upon the particular component and other adjuvants used (if any), on the fluid or propellant, and on the particular insulin combination being used. Conventional neoprene and buna valve rubbers used in metered dose valves for delivering conventional CFC formulations often have less than optimal valve delivery characteristics and ease of operation when used with formulations containing HFC-134a or HFC-227. Therefore certain formulations of the invention are preferably dispensed via a valve assembly wherein the diaphragm is made of a nitrile rubber such as DB-218 (American Gasket and Rubber, Schiller Park, Ill.) or an EPDM rubber such as Vistalon(trademark) (Exxon), Royalene(trademark) (UniRoyal), BunaEP (Bayer). Also suitable are diaphragms fashioned by extrusion, injection molding or compression molding from a thermoplastic elastomeric material such as FLEXOMER(trademark) GERS 1085 NT polyolefin (Union Carbide).
Conventional aerosol canisters, coated or uncoated, anodized or unanodized, e.g., those of aluminum, glass, stainless steel, polyethylene terephthalate, and coated canisters or cans with epon, epoxy, etc., can be used to contain a formulation of the invention.